7211 Evaluation of conscious sedation for endoscopy in germany.

Abstract

Background: The use of intravenous sedation for endoscopic procedures differs considerable between countries. The aim of this nationwide survey was to assess frequency and mode of sedation, monitoring and reanimation facilities in endoscopy units, as well as morbiditiy and mortality associated with endoscopy in Germany. Methods: A questionnaire was sent as enclosure in the Zeitschrift für Gastroenterologie” to all German gastroenterologists. Results: 271 questionnaires ( 81 private practice, 190 hospitals )were returned. In these units a total of 774 147 endoscopies were performed per year. Conscious sedation was given regularly by 60 % of colleagues, occasionally by 20% and procedure related by 11%. Whilst 13% of gastroscopies were performed without premedication, only 1% of colonoscopies and none of the ERCP`s were done this way. Only in 7% a fixed scheme was given, whereas in 93% it was related to the individual patient. Benzodiazepines were the drugs most often applied (93%), followed by opiates and propofol. A single substance was given in 46%, however in 54% combination therapies were preferred. Flumazenile was given routinely by 44% and only for patients at risk by 55%. 90%of the endoscopists have received training in intensive care units and 93% have the facilities for reanimation in their endoscopy units. Intravenous access was routinely maintained by 68% of the endoscopists and in 11% either for high-risk patients or procedure related. In 85% patients were monitored routinely by pulse oximetry, in 23% by an electrocardiogram and 32% were monitored additionally by a second trained person. Anaesthesiologists were only present in 5%. The endoscopists monitored their patients for a time period between 10 min and 1 hour in 52% and more than one hour in 38%. Premedication related complications were reported by 52 % of colleagues fatal complications by 9%. Related to the number of endoscopies, sedation related morbidity and mortality were 0,0001 and 0,000001%. Complications and deaths correlated with gastroenterologists working in a hospital and performing a great number of endoscopies, as well as monitoring patients for more than 1 hour. The way of monitoring had no influence. Conclusion: Despite a great acceptance of conscious sedation morbidity and mortality is significantly lower than reported in USA. This may be due to the fact that German gastroenterologists are trained in intensive therapy, and mostly administer drugs not in a fixed scheme. Complications seem to be related to difficult procedures in high risk patients. Background: The use of intravenous sedation for endoscopic procedures differs considerable between countries. The aim of this nationwide survey was to assess frequency and mode of sedation, monitoring and reanimation facilities in endoscopy units, as well as morbiditiy and mortality associated with endoscopy in Germany. Methods: A questionnaire was sent as enclosure in the Zeitschrift für Gastroenterologie” to all German gastroenterologists. Results: 271 questionnaires ( 81 private practice, 190 hospitals )were returned. In these units a total of 774 147 endoscopies were performed per year. Conscious sedation was given regularly by 60 % of colleagues, occasionally by 20% and procedure related by 11%. Whilst 13% of gastroscopies were performed without premedication, only 1% of colonoscopies and none of the ERCP`s were done this way. Only in 7% a fixed scheme was given, whereas in 93% it was related to the individual patient. Benzodiazepines were the drugs most often applied (93%), followed by opiates and propofol. A single substance was given in 46%, however in 54% combination therapies were preferred. Flumazenile was given routinely by 44% and only for patients at risk by 55%. 90%of the endoscopists have received training in intensive care units and 93% have the facilities for reanimation in their endoscopy units. Intravenous access was routinely maintained by 68% of the endoscopists and in 11% either for high-risk patients or procedure related. In 85% patients were monitored routinely by pulse oximetry, in 23% by an electrocardiogram and 32% were monitored additionally by a second trained person. Anaesthesiologists were only present in 5%. The endoscopists monitored their patients for a time period between 10 min and 1 hour in 52% and more than one hour in 38%. Premedication related complications were reported by 52 % of colleagues fatal complications by 9%. Related to the number of endoscopies, sedation related morbidity and mortality were 0,0001 and 0,000001%. Complications and deaths correlated with gastroenterologists working in a hospital and performing a great number of endoscopies, as well as monitoring patients for more than 1 hour. The way of monitoring had no influence. Conclusion: Despite a great acceptance of conscious sedation morbidity and mortality is significantly lower than reported in USA. This may be due to the fact that German gastroenterologists are trained in intensive therapy, and mostly administer drugs not in a fixed scheme. Complications seem to be related to difficult procedures in high risk patients.